Pathophysiology of sinusitis of odontogenic origin

Abstract

Sinusitis of odontogenic origin, which is frequently encountered in routine otolaryngological and dental clinical practice, has been described as a reactive maxillary inflammation secondary to maxillary tooth infection or trauma to an odontogenic disease of maxillary bone, dental extractions, implant placement, or endodontic treatment impairing the integrity of the Schneiderian membrane. The aim of the present review was to investigate and discuss the most recent pathophysiological findings, predisposing odontogenic factors, microbiology, and the possible involvement of bacterial biofilms (BB) in the development of sinusitis. The narrative literature review showed that there might be a correlation between the bacteria present in pathological teeth in communication with the sinus and those found in infected sinus. The formation of a BB might be also involved in the etiopathogenesis of sinusitis of odontogenic origin. In conclusion, the true origin of odontogenic sinusitis is still unresolved. In clinical terms, the choice of suitable therapy depends on the characteristics of the biofilm. Further microbiological studies are required to better investigate the role of BB.

Optimal timing of endoscopic sinus surgery for odontogenic sinusitis

“…Bauer showed that inflammation and infection from tooth roots could spread through maxillary alveolar bone and sinus mucosa, thereby causing sinus inflammation and infection . Various odontogenic pathologies can cause ODS, including pulpitis, periapical lesions (cysts, abscesses, granulomas), periodontitis, oroantral fistula (OAF), or dental treatment‐related sinus foreign bodies . Large series and meta‐analyses have shown that the main dental etiologies of ODS are extraction‐related OAFs, periapical, and periodontal disease …”

“…8 Various odontogenic pathologies can cause ODS, including pulpitis, periapical lesions (cysts, abscesses, granulomas), periodontitis, oroantral fistula (OAF), or dental treatment-related sinus foreign bodies. 9,10 Large series and meta-analyses have shown that the main dental etiologies of ODS are extraction-related OAFs, periapical, and periodontal disease. [11][12][13][14] ODS is diagnosed in a fashion similar to other forms of sinusitis: history to detect sinusitis symptoms, nasal endoscopy to assess for inflammation or infection, and computed tomography (CT) imaging to assess sinusitis extent but also maxillary odontogenic pathology.…”

Histopathology of maxillary sinus mucosa with odontogenic maxillary sinusitis

“…Regarding the etiology, various odontogenic pathologies can cause OMS, including pulpitis, periapical lesions, periodontitis, oroantral fistulas, or foreign bodies in the sinus related to dental treatment . However, the presence of periapical lesions is significantly associated with the thickening of the maxillary sinus mucosa and to OMS .…”

Unusual case of bilateral maxillary fungus ball

“…Particularly, endodontic treatments are considered one of the most important risky procedures for maxillary pathology: in fact, during this procedure, the endodontic material, which contains zinc oxide-eugenol, facilitates the growth of Aspergillus fumigatus , paralyses the mucosa-cilia and induces soft-tissue oedema 1 13. Another common consequence of teeth inflammatory process is the formation of odontogenic cyst, whose origin is still unclear:2 14 15 this cyst could be another odontogenic focus from which an odontogenic rhinosinusitis may occur.…”

“…They are generally regarded as maxillary-only sinusitis arising from dental pathology, featuring unilateral nasal obstruction and/or purulent discharge, pain or pressure on the maxillary area and cacosmia 1. Patients may also have episodes of gravel-like discharge from their nose 2…”